Sidebar: Six vectors shaping the customized framework

The transformation of our health system from one that is reactive into one that anticipates, understands, and supports people in managing their own health is a massive undertaking. To get there, health industry leaders are focusing on six crucial areas.

Incentives that encourage partnerships.

Setting transparent, patient-centered goals that encourage partnerships between patients and their physicians will be crucial to success. Performance-based payment methods embed incentives that prompt stakeholders to collaborate with payers and regulators. However, many companies are starting to think about diseases differently by partnering with other organizations on products and services to achieve health outcomes. In the US, accountable care organizations are being developed as pilots for Medicare under a financial structure of shared bonuses. Physicians and hospitals would be accountable jointly for the cost and quality of care to a set population.

Regulatory reforms.

Many of the world’s largest economies are tackling major regulatory reforms that will alter how medical-delivery organizational structures and funding mechanisms can drive personal behaviors that in turn impact health costs. Because governments spend so much of their budgets on healthcare, regulatory reform is a constant process. Reform discussions increasingly wrap around metrics that, while patient centered, are population based. At the same time, policy makers worry that personalization is evolving beyond population-based metrics because what works for the majority does not work for all. Regulatory reform is also addressing behavioral, genetic, and medical system influencers.

Funding that redistributes spending.

Payment and financing are migrating from funding the treatment of sick patients to initiatives to keep them well in the first place. The move to coordinated-care pathways is the beginning of a shift in funding from treating sick patients to keeping them well. However, for the new models to succeed, stakeholders must be familiar with the ways they can work seamlessly together. The traditional iconic and visible symbol of the health system in a community is the hospital, which exists to offer acute care, not chronic-disease management. While technology enables more services to move from hospitals to outpatient, home, and clinic settings, hospitals and communities are sometimes reluctant to abandon their capital-intensive structures. However, with limited funding, slices of the spending pie will have to be reallocated. In some cases, this will mean expanding the traditional physician team to include nurses, nutritionists, and others.

Patient communication that supports choice.

Individuals benefit from better information, education, and communication materials that support shared decision making and choice. In our survey of global health leaders, we asked about the most effective strategy for engaging individuals in their own health. The top answers revolved around patient education and communication. Technology is playing an important role, and to better meet consumers’ expectations and achieve good outcomes, some providers are segmenting their patients by technology skill set. Online databases, social networking, and virtual communities are creating new ways to share information that individuals can understand.

Information technology that eases collaboration.

Interoperable electronic health records are the connective tissues that will support individuals in taking on a collaborative role in their own care. By 2020, health systems will have moved from paper records controlled by the industry to digital ones controlled by patients. Issues around opting in, opting out, consent, privacy and security, legal ownership of the record, and legal protection for clinicians making decisions using information controlled by patients are still being debated. However, 85 percent of global health leaders said making EHRs available to clinicians would make their health systems more efficient by reducing duplication; 71 percent said providing patient access would make them more efficient by means of enhanced self-management.

Flexible workforce models.

As demand for health services has grown, so have workforce shortages. Those shortages are breaking down traditional delivery hierarchies and creating new roles. Many countries are investing in the education of more and more doctors and nurses, yet the optimal number of clinicians needed is debatable because current processes are inefficient and siloed. Shortages will always exist in the absence of new models that emphasize coordination of care. However, healthcare professionals could feel threatened by new models. As a result, new models can be disruptive and nurture a culture of depersonalization—running counter to patients’ demands for customized care and services. Even though technology is enabling customization, it’s important to recognize that people remain at the heart of healthcare.